Done with bone marrow biospy test. What are the findings?

I had asked a question to Dr. XXXXXXX XXXXXXX and closed the conversation, I have some new test findings I would like to ask him about since he has my history and has already reviewed my bone marrow biospy test. Is it possible to have him answer my new question?

Follow-up: Done with bone marrow biospy test. What are the findings? 13 minutes later

Dear Dr. XXXXXXX
I had a peripheral blood smear done on 3-8-13 last week and it showed Neutrophils with left shift to band level. WBC 3.9, Lym 49.2, Mid 8.6, Gran 42.2, RBC 4.19, HGB 13.7, HCT 39.8, MCV 95.1, MCH 32.7 MCHC 34.4, RDW 12.8, PLT 265 MPV 7.7.
Comment on report said "While a left shift of the myeloid seriese can be seen in low grade myeloid stem cell neoplasms, Inflammatory/ reactive conditions may also present with the feature. There is now evidence of acute leukemia or non'Hodgkins lymphoma. If there is persistent clinical concern for an underlying myeloid stme cell neoplasm, then bone marrow evaluation should be considered. The peripheral blood smear is adequate for evaluation. RBC's are normochromic normocytic. Neutrophils show a slight left shift to band level. Monocytes and lymphocytes are unremardable. Platelets are adeuate in number and morphology. Circulating blasts are not identified.
I know that the left shift means I have immature Neutrophils that they cannot rule out MDS. Also aren't immature cells blasts? I had a bone marrow done a year ago XXXXXXX of 2012 and sent that report to Dr. XXXXXXX for his review. They could not rule out MDS on that test due to Erythrocytes: Complete maturation, mild dyserythropoiesis. I have chronic Neutropenia, my WBC runs 2.4-3.0, neutrohils run 1.1-1.6. RBC's and platelets are always normal range. Should I have another bone marrow biopsy, due to this new finding on my peripheral smear, the left shift to band level on Neutrophils?
Sincerely,
XXXXXXX

Answered by Dr. Robert Galamaga 3 hours later

answer Id 157459; conversation id 155133

Hello again,

Thank you again for the additional information and question. As far as your concern regarding the white blood cells when a pathologist comments on a left shift in a powerful blood smear this does not suggest an acute leukemia. I don't want you to focus on these types of words because at this time it does not indicate a worrisome process in my opinion. Left shift does not serve as an equivalent of blasts. Blasts are extremely abnormal immature cells and in your case there is no evidence of any of these on your peripheral blood smear observation. If this were the case the pathologist would have certainly commented upon that.

At this time I do not see any indication for a repeat good range. I really think watchful observation is the best way to approach this.

I completely understand your concern and your interest in being very vigilant about following this but it appears that your doctors are doing a good job.

Thanks again for sending your question. Please let me know if you have any additional concerns.

Follow-up: Done with bone marrow biospy test. What are the findings? 3 hours later

Thank you for your quick response. I had a CBC done today and here are the results. WBC 3.8, my Neurtorphils were the lowest I have ever seen them at 22, normal being 36-76, my Lymphs were high at 63, normal 20-45, Absolute Neutrophils 1.0 normal 1.3-7.4, no number given for Absolute lymphs, RBC 4.11, Hgb 13.4, Hct 38.8, everything else normal range. Is this bad to have my Neutrophils low at 22 and lymphs at 63, I am even more worried now. I know you stated not to be worried about acute Leukemia but my conern is a low grade MDS as they keep stating it cannot be ruled out in all my reports, I realize it's a possibility but how much of a possibility and now my Neutrophils are so low and Lymphs high.
I would greatly appreciate your input, please help.
Sincerely very worried,

My CBC on March 7 last Thursday was WBC 3.9, Neutrophils or Gran 42.2 percent, Absolute Gran 1.6 normal 2.0-7.8, Lym 49.2 percent Absolute Lymp 1.9 normal. RBC was 4.19 so it has come down today to 4.11. Why such a drastict drop in my Neutrophils and rise in Lymphocytes in 5 days? Neuts 22 percent Lymph 63 percent today, is the absolute number the more important number? I don't understand any of this.

Sorry to being sending so many messages but I keep seeing something else new on my CBC, I just noticed my Baso cells are high at 4 normal being 0-1. Everything I read points to MDS or Leukemia.

The CBC I had done today with high Lymph, high Baso low Neut was manual, the past ones were Auto Diff, thought you should know that. Also the Baso 4 was percent, no absolute for baso, 0-1 being normal. I know this cannot be good I spoke with the Tech at the Lab and he even sounded concerned.
XXXXXXX

Answered by Dr. Robert Galamaga 13 hours later

answer Id 157464; conversation id 155481

I am not concerned with the results you have indicated. There is no indication to check the CBC any more frequently than every few months. Please tea over our previous exchanges as I would be repeating everything once again to reassure you.

Your neutrophil count is slightly decreased and this needs interval monitoring. Please followup with your hematologist. The other counts will fluctuate including the basophils. No need to be alarmed right now.

Follow-up: Done with bone marrow biospy test. What are the findings? 31 hours later

Dear Dr. XXXXXXX
Thank you for your response. Well the good news is that they had to do a addendum on the counts I gave you on the last CBC that worried me. My Neutrophils were 33 not 22, Lymps 55 not 63, Baso 1 not 4, and on the Manual Band count was 2 not 3. I don't know how it was miss read the first time I am just thankful it was corrected and the counts were better. I know Bands are immature cells and the normal range on this last report I got is 0-11, the previous smear said a "left shift", but that was a different Pathologist. What I read was they call it a "left shift" when the percentage is to high, but on this last report my band percentage is within normal values and the Pathologist made no comment about cannot rule out a low MDS, I am not worried just wondering how one report will say one thing and another says another. Is it normal to have a low band percentage? I am not so worried now, all I can do is keep an eye on it, I just like to have a good understanding about all these test. Thank you for your patience and understanding, you are most kind.
Sincerely relieved,
XXXXXXX

Answered by Dr. Robert Galamaga 2 hours later

answer Id 157466; conversation id 156231

Hello again.

With subsequent complete blood count test there will always be a fluctuation in the numbers of cells within each subset of your white blood cells. Regarding interpretation of the actual blood count this again may fluctuate depending on which physician is interpreting the results. A left shift does not always mean a pathological issue. This may be just a reflection of a point in time where there is an increase in the more immature neutrophils. This can happen for number reasons including exposure to a virus in the environment. Again this is not something i would worry about right now.

Generally the band percentage is usually relatively low. That is a normal finding.

I encourage you to continue to observe things for the time being. I would not check another blood count for at least three months.

Thanks again for sending your question. Please do not hesitate to contact me with any additional concerns.